OBJECTIVE: The goal of this paper was to describe how endoscope-assisted oblique lumbar interbody fusion (OLIF) could remove huge lumbar disc herniation (HLDH) manifested with cauda equina syndrome (CES). METHODS: In this study, the authors made an attempt to treat CES with a direct endoscopic decompression through the OLIF corridor and performed OLIF in two patients with HLDH. RESULTS: Two patients with HLDH were successfully treated using OLIF with spinal endoscopic discectomy...

AIMS OF THE STUDY: To assess the cost-effectiveness of primarily surgical treatment (PST) versus primarily conservative treatment (PCT) in adults with intermediate severity, acute or subacute, lumbar radicular syndrome due to intervertebral disc herniation. METHODS: A decision analytic model from healthcare system and societal perspectives was used to compare outcomes and costs of PST with those of PCT (physiotherapy, epidural injection and medication). Treatment pathways and quality of life were obtained from published clinical trials...

BACKGROUND: Intervertebral disc degeneration (IVDD) is considered a multifactorial disease that is influenced by both environmental and genetic factors. The last two decades of research strongly demonstrate that genetic factors contribute about 75% of the IVDD etiology. Recent total genome sequencing studies have shed light on the various single-nucleotide polymorphisms (SNPs) that are associated with IVDD. AIM: This review presents comprehensive and updated information about the diversity of genetic factors in the inflammatory, degradative, homeostatic, and structural systems involved in the IVDD...

BACKGROUND: Lumbar disc disease has a disabling impact on global people with heavy burden on society, mainly consisting of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH). The recently released lumbar disc nomenclature version 2.0 deepens our understandings on the diseases. Consequently, there is an urgent need to clarify the occurrence and distribution features of LDD and LDH in a large-scale sample in terms of the novel version. QUESTION/PURPOSES: We asked: (1) Is there a difference in the occurrence and distribution hallmarks of LDD and LDH in a population-based large-scale sample? (2) Does the novel nomenclature version bring novel vision on lumbar disc disease? METHODS: Five thousand two hundred eighty-eight consecutive cases (26,440 lumbar discs) undergoing lumbar spine MRI were retrospectively included from Jan 2008 to Dec 2010 in a territory university hospital...

BACKGROUND: Drop foot resulting from degenerative lumbar diseases can impair activities of daily living. Therefore, predictors of recovery of this symptom have been investigated using univariate or/and multivariate analyses. However, the conclusions have been somewhat controversial. Bayesian network models, which are graphic and intuitive to the clinician, may facilitate understanding of the prognosis of drop foot resulting from degenerative lumbar diseases. QUESTIONS/PURPOSES: (1) To show a layered correlation among predictors of recovery from drop foot resulting from degenerative lumbar diseases; and (2) to develop support tools for clinical decisions to treat drop foot resulting from lumbar degenerative diseases...

INTRODUCTION: Since Kambin introduced the concept of percutaneous transforaminal disc surgery in 1973, there has been numerous advances in the field of spine endoscopy and the concept of central debulking of the disc has changed to targeted fragmentectomy and disc preservation. The lumbar disc fragments which are down migrated and to the medial aspect of the pedicle are extremely challenging to deal by transforaminal approach even after foraminoplasties and by various other approaches...

OBJECTIVES: Posterior lumbar interbody fusion (PLIF) is usually bilateral procedure, and it is combined with posterior by bilateral pedicle screw support or with fixation. The purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and PLIF without pedicle screw support in patients with lumbar disc herniation (LDH). PATIENTS AND METHODS: 60 patients with single segment LDH were operated between February 2010 and June 2013. 40 patients were treated with simple discectomy (Group 1) and 20 patients were treated with PLIF using double expandable polyetheretherketone (PEEK) cages without instrumentation (Group 2) unilaterally...

BACKGROUND: Herniated lumbar discs can induce sciatica by mechanical compression and/or chemical irritation. It was recently reported that neuroglial cellular activity after pulsed radiofrequency (PRF) application to a single dorsal root ganglion (DRG) attenuated neuroglial activity at the corresponding spinal dorsal horn. Recently, caudal epidural PRF has been used to manage neuropathic pain, but evidence of molecular changes after the administration of caudal epidural PRF to attenuate neuropathic pain is lacking, and it has not been determined whether caudal epidural PRF affects neuroglial activity at different spinal levels...

BACKGROUND: Open lumbar microdiscectomy (OLM) has been considered the gold standard in the management of lumbar disc herniation (LDH) for its favorable outcomes in long-term follow-up. Nowadays, percutaneous endoscopic lumbar discectomy (PELD) is gaining recognition. However, greatest limitation of studies of PELD is the lack of long-term follow-up outcomes. OBJECTIVE: To investigate the long-term outcomes of PELD in terms of clinical and radiographic findings and revision surgery rate...

Entrapment neuropathies of the fibular nerve and its branches are often underdiagnosed due to the lack of reliable diagnosis using clinical examination and electrophysiologic evaluation. Most fibular nerve compressions may be classified into 2 broad categories: (a) mechanical causes, which occur at fibrous or fibro-osseous tunnels, and (b) dynamic causes related to nerve injury during specific limb positioning. Foot drop resulting from weakness of the dorsiflexor muscles of the foot is a relatively uncommon presentation and closely related to L5 neuropathy caused by a disc herniation...

The pathogenesis of pain in lumbar disc herniation (LDH) remains poorly understood. We have recently demonstrated that voltage-gated sodium channels (VGSCs) in dorsal root ganglion (DRG) neurons were sensitized in a rat model of LDH. However, the detailed molecular mechanism for sensitization of VGSCs remains largely unknown. This study was designed to examine roles of the endogenous hydrogen sulfide synthesizing enzyme cystathionine β-synthetase (CBS) in sensitization of VGSCs in a previously validated rat model of LDH...

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To determine the effects of insurance type (Medicaid vs. a specific private insurance) on patient access to spine surgeons for lumbar disc herniation as measured by (1) acceptance of insurance, (2) need for a referral, and (3) wait time for appointment. SUMMARY OF BACKGROUND DATA: Limited studies have been conducted to examine the issue of patient access to spine surgeons based on different insurance types (Medicaid vs...

Giant intrapelvic malignant peripheral nerve sheath tumors arising in the sciatic nerve in the pelvic cavity are a rare occurrence and their symptomatology is usually misdiagnosed as intervertebral disc herniation. We herein report the case of a 46-year old woman presenting with pain, hypesthesia and weakness of the left lower extremity due to a giant intrapelvic malignant peripheral nerve sheath tumor of the sciatic nerve. Prior to being referred to our institution, the patient was misdiagnosed as a case of sciatica due to a lumbar disc herniation and underwent an operation unsuccessfully, as there was little symptomatic improvement 2 months after the surgery...

The improvement of pain and functionality is the major goal of a surgical intervention. Thus, the purpose of the present prospective study was to evaluate whether subjective sensory deficits in patients with lumbar radiculopathy caused by a lumbar disc herniation are related to clinical status, using several outcome scores and the quantitative sensory testing (QST) pre- and 12 months postoperatively. We applied the QST in 52 patients with a single lumbar disc herniation treated by lumbar sequestrectomy pre- and 12 months postoperatively...

OBJECTIVES: To study 1)the efficacy of transforaminal percutaneous endoscopic lumbar discectomy in lumbar disc herniations.2) limitations and advantages of the surgical procedure. 3)morbidity and complications associated with the procedure. MATERIALS AND METHODS: This study was carried out on 120 patients who had single level herniated disc Pre-operative assessment of VAS and MSS scoring systems were documented one day prior to surgery. Post operative results were determined by MacNab criteria and by modified Suezawa and Schreiber clinical scoring system (MSS score)...

OBJECTIVE: Percutaneous endoscopic lumbar discectomy and percutaneous epidural neuroplasty is a commonly used minimally invasive spinal surgery in lumbar disc herniation. But to our knowledge, there is no report about the results of percutaneous endoscopic lumbar discectomy with percutaneous epidural neuroplasty. We did this study to evaluate the effect of percutaneous endoscopic lumbar discectomy with percutaneous epidural neuroplasty in lumbar disc herniation. METHODS: We report the series of cases about technics and results of percutaneous endoscopic lumbar discectomy with percutaneous epidural neuroplasty in lumbar disc herniation...

Facet injuries are common in the cervical spine. Many classification systems over the years have characterized the heterogeneity of these injuries. For unilateral facet fractures with minimal displacement and no neurological deficit, there is mounting evidence that better radiographic and clinical outcomes may be achieved with surgical treatment. Anterior and posterior approaches can both be utilized successfully for the surgical management of facet injuries. The anterior approach is well tolerated, allows one to address a disc herniation, and provides a high union rate with good sagittal alignment...

PURPOSE: Indicating lumbar disc herniation via magnetic resonance imaging (MRI) T2 mapping in the posterior annulus fibrosus (AF). METHODS: Sagittal T2 maps of 313 lumbar discs of 64 patients with low back pain were acquired at 3.0 Tesla (3T). The discs were rated according to disc herniation and bulging. Region of interest (ROI) analysis was performed on median, sagittal T2 maps. T2 values of the AF, in the most posterior 10% (PAF-10) and 20% of the disc (PAF-20), were compared...